§256 Grants to Strengthen the Effectiveness, Efficiency, and Coordination of Services for the Uninsured and Underinsured

Summary

Allows the Secretary to give grants to groups that help build joined-up local health systems for people who are uninsured or underinsured. The grants fund work to make care more efficient and better coordinated, to prevent and manage chronic disease, and to expand services. To qualify, a group must be a consortium whose main goal is to deliver many kinds of coordinated care for a named community. The consortium should include, when available, a Federally Qualified Health Center, a hospital with a low-income use rate over 25%, a public health department, and at least one other provider or organization that serves the uninsured. The application must define the community, list participating providers and their roles, describe planned activities, show community involvement, explain how care will be coordinated and sustained, show plans to enroll eligible people in public or private coverage, show financial responsibility, and include an evaluation plan. Priority is given to proposals that show big unmet need, a history of serving the uninsured, plans to expand primary and preventive care (including mental health and substance abuse services), better coordination with social services and governments, strong use of nonfederal funds, and a plan to keep going after the grant ends. Examples of allowed uses include outreach, case management, transportation, building provider networks, hiring and training staff, buying technology to share information, creating shared eligibility systems, disease management tools, translation services, and other steps to increase access. Grants are limited in number and time. For fiscal years 2003–2006, no more than 35 new awards may be made each year (not counting renewals). A grantee normally may get money for at most 3 straight fiscal years, with one extra year allowed only if the Secretary agrees that “extraordinary circumstances” (like a natural disaster or major local economic decline) stopped the consortium from meeting its goals. No more than 15% of a grant may be spent on direct patient care, and the Secretary may use up to 3% of appropriated funds for technical help, evaluation, and sharing lessons. Grantees must report yearly on progress and have an independent financial audit. Each applicant and participating provider must keep nonfederal spending at least at the level it was in the year before the grant. The Secretary must report to Congress by September 30, 2005, on how well projects worked. Demonstration awards may be made to historically black health professions schools for research and training tied to these programs. Funds are authorized as needed for fiscal years 2002 through 2006 and cannot be appropriated after September 30, 2006.